UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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Updated Topics in Minimally Invasive Abdominal Surgery
that the advantages of laparoscopic cholecystectomy are more rapid recovery of lung
function and a shorter stay in hospital. Catani [4] declared that changes in cardiovascular
function due to the insufflation are characterized by an immediate decrease in cardiac index
and an increase in mean arterial blood pressure and systemic vascular resistance.
2.1 Cases
Popken et al [1] published a study regarding patients with cardiopulmonary impairment
where they used laparoscopic cholecystectomy in 19 high-risk patients (ASA IV) and 465
patients with a lower operative risk (ASA I-III). The authors state that out of 484 patients,
there were 5 percent who suffered intraoperative cardiopulmonary complications. There
were three who belonged to the high-risk group (15.8%) and 21 to the lower risk groups
(4.5%). There were general postoperative complications that occurred in 14 cases (2.9%). The
authors noted that the number of days spent in hospital was 4.96 to 7.6 in average days in
the high-risk group versus 2.23 to 4.8 days in groups ASA I-III. They concluded that highrisk
patients shows a raise perioperative rate of complications in laparoscopic
cholecystectomy but they also stated that it is not basically a contraindication for this
operative method.
Tillman et al. [2] also investigated their laparoscopic cholecystectomy cases in 17 patients
with severe cardiac dysfunction. They reported that there were three of the 17 patients who
required administration of nitroglycerin to maintain the MAP and SVR within the accepted
limits while one also required administration of dobutamine to maintain CI. There was no
myocardial morbidity or mortality in the perioperative period according to their report.
They concluded that laparoscopic cholecystectomy in patients with severe cardiac
dysfunction results in significant hemodynamic changes.
3. Patients with diabetes mellitus
It has been believed that patients with diabetes mellitus is considered before as a risk factor
in patients who undergo laparoscopic cholecystectomy commonly because of symptomatic
gallbladder stones. [5] This is due to reports (Chang,M.D) [6] that a high plasma glucose level is
associated with a poor neurologic recovery score in patients after cardiopulmonary